MEDICARE: JENNIFER ELIZABETH ROSEN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	125267	CA

General Provider Information

NPI Number	:	1720668460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELIZABETH ROSEN LMFT

Provider Business Mailing Address
First Line	:	16060 VENTURA BLVD STE 110
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4428
Country	:	US
Telephone Number	:	310-927-0013
Fax Number	:

Provider Business Practice Location Address
First Line	:	16060 VENTURA BLVD STE 110
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4428
Country	:	US
Telephone Number	:	310-927-0013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	05/04/2021

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